Addie Peretz

All Publications

• Long-Term Epidural Patching Outcomes and Predictors of Benefit in Patients With Suspected CSF Leak Nonconforming to ICHD-3 Criteria. Neurology Carroll, I., Han, L., Zhang, N., Cowan, R. P., Lanzman, B., Hashmi, S., Barad, M. J., Peretz, A., Moskatel, L., Ogunlaja, O., Hah, J. M., Hindiyeh, N., Barch, C., Bozkurt, S., Hernandez-Boussard, T., Callen, A. L. 2024; 102 (12): e209449

  Abstract

  Spinal CSF leaks lead to spontaneous intracranial hypotension (SIH). While International Classification of Headache Disorders, Third Edition (ICHD-3) criteria necessitate imaging confirmation or low opening pressure (OP) for SIH diagnosis, their sensitivity may be limited. We offered epidural blood patches (EBPs) to patients with symptoms suggestive of SIH, with and without a documented low OP or confirmed leak on imaging. This study evaluates the efficacy of this strategy.We conducted a prospective cohort study with a nested case-control design including all patients who presented to a tertiary headache clinic with clinical symptoms of SIH who completed study measures both before and after receiving an EBP between August 2016 and November 2018.The mean duration of symptoms was 8.7 ± 8.1 years. Of 85 patients assessed, 69 did not meet ICHD-3 criteria for SIH. At an average of 521 days after the initial EBP, this ICHD-3-negative subgroup experienced significant improvements in Patient-Reported Outcomes Measurement Information System (PROMIS) Global Physical Health score of +3.3 (95% CI 1.5-5.1), PROMIS Global Mental Health score of +1.8 (95% CI 0.0-3.5), Headache Impact Test (HIT)-6 head pain score of -3.8 (95% CI -5.7 to -1.8), Neck Disability Index of -4.8 (95% CI -9.0 to -0.6) and PROMIS Fatigue of -2.3 (95% CI -4.1 to -0.6). Fifty-four percent of ICHD-3-negative patients achieved clinically meaningful improvements in PROMIS Global Physical Health and 45% in HIT-6 scores. Pain relief following lying flat prior to treatment was strongly associated with sustained clinically meaningful improvement in global physical health at an average of 521 days (odds ratio 1.39, 95% CI 1.1-1.79; p < 0.003). ICHD-3-positive patients showed high rates of response and previously unreported, treatable levels of fatigue and cognitive deficits.Patients who did not conform to the ICHD-3 criteria for SIH showed moderate rates of sustained, clinically meaningful improvements in global physical health, global mental health, neck pain, fatigue, and head pain after EBP therapy. Pre-treatment improvement in head pain when flat was associated with later, sustained improvement after EBP therapy among patients who did not meet the ICHD-3 criteria.This study provides Class IV evidence that epidural blood patch is an effective treatment of suspected CSF leak not conforming to ICHD-3 criteria for SIH.

  View details for DOI 10.1212/WNL.0000000000209449

  View details for PubMedID 38820488

• Safety of remote electrical neuromodulation for acute migraine treatment in pregnant women: A retrospective controlled survey-study. Headache Peretz, A., Stark-Inbar, A., Harris, D., Tamir, S., Shmuely, S., Ironi, A., Halpern, A., Chuang, L., Riggins, N. 2023

  View details for DOI 10.1111/head.14586

  View details for PubMedID 37335242

• Understanding Headache Education Training Practices in US Neurology Residency Programs Pham, K., Tran, S., Baron, R., Peretz, A. WILEY. 2023: 111-112

  View details for Web of Science ID 001043094900147

• Safety of Remote Electrical Neuromodulation in Pregnant Women with Migraine Peretz, A., Stark-Inbar, A., Harris, D., Ironi, A., Halpern, A., Chuang, L., Riggins, N. WILEY. 2023: 167-168

  View details for Web of Science ID 001043094900229

• Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi-center study. Headache Cowan, R. P., Rapoport, A. M., Blythe, J., Rothrock, J., Knievel, K., Peretz, A. M., Ekpo, E., Sanjanwala, B. M., Woldeamanuel, Y. W. 2022

  Abstract

  OBJECTIVE: This study assesses the concordance in migraine diagnosis between an online, self-administered, Computer-based, Diagnostic Engine (CDE) and semi-structured interview (SSI) by a headache specialist, both using International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria.BACKGROUND: Delay in accurate diagnosis is a major barrier to headache care. Accurate computer-based algorithms may help reduce the need for SSI-based encounters to arrive at correct ICHD-3 diagnosis.METHODS: Between March 2018 and August 2019, adult participants were recruited from three academic headache centers and the community via advertising to our cross-sectional study. Participants completed two evaluations: phone interview conducted by headache specialists using the SSI and a web-based expert questionnaire and analytics, CDE. Participants were randomly assigned to either the SSI followed by the web-based questionnaire or the web-based questionnaire followed by the SSI. Participants completed protocols a few minutes apart. The concordance in migraine/probable migraine (M/PM) diagnosis between SSI and CDE was measured using Cohen's kappa statistics. The diagnostic accuracy of CDE was assessed using the SSI as reference standard.RESULTS: Of the 276 participants consented, 212 completed both SSI and CDE (study completion rate=77%; median age=32years [interquartile range: 28-40], female:male ratio=3:1). Concordance in M/PM diagnosis between SSI and CDE was: kappa=0.83 (95% confidence interval [CI]: 0.75-0.91). CDE diagnostic accuracy: sensitivity=90.1% (118/131), 95% CI: 83.6%-94.6%; specificity=95.8% (68/71), 95% CI: 88.1%-99.1%. Positive and negative predictive values=97.0% (95% CI: 91.3%-99.0%) and 86.6% (95% CI: 79.3%-91.5%), respectively, using identified migraine prevalence of 60%. Assuming a general migraine population prevalence of 10%, positive and negative predictive values were 70.3% (95% CI: 43.9%-87.8%) and 98.9% (95% CI: 98.1%-99.3%), respectively.CONCLUSION: The SSI and CDE have excellent concordance in diagnosing M/PM. Positive CDE helps rule in M/PM, through high specificity and positive likelihood ratio. A negative CDE helps rule out M/PM through high sensitivity and low negative likelihood ratio. CDE that mimics SSI logic is a valid tool for migraine diagnosis.

  View details for DOI 10.1111/head.14324

  View details for PubMedID 35657603

• The role of urgent care centers in headache management: a quality improvement project. BMC health services research Minen, M. T., Khanns, D., Guiracocha, J., Ehrlich, A., Khan, F. A., Ali, A. S., Birlea, M., Singh, N. N., Peretz, A., Larry Charleston, I. V. 2022; 22 (1): 162

  Abstract

  BACKGROUND: Patients with headache often seek urgent medical care to treat pain and associated symptoms that do not respond to therapeutic options at home. Urgent Cares (UCs) may be suitable for the evaluation and treatment of such patients but there is little data on how headache is evaluated in UC settings and what types of treatments are available. We conducted a study to evaluate the types of care available for patients with headache presenting to UCs.DESIGN: Cross-Sectional.METHODS: Headache specialists across the United States contacted UCs to collect data on a questionnaire. Questions asked about UC staffing (e.g. number and backgrounds of staff, hours of operation), average length of UC visits for headache, treatments and tests available for patients presenting with headache, and disposition including to the ED.RESULTS: Data from 10 UC programs comprised of 61 individual UC sites revealed: The vast majority (8/10; 80%) had diagnostic testing onsite for headache evaluation. A small majority (6/10; 60%) had the American Headache Society recommended intravenous medications for acute migraine available. Half (5/10) had a headache protocol in place. The majority (6/10; 60%) had no follow up policy after UC discharge.CONCLUSIONS: UCs have the potential to provide expedited care for patients presenting for evaluation and treatment of headache. However, considerable variability exists amongst UCs in their abilities to manage headaches. This study reveals many opportunities for future research including the development of protocols and professional partnerships to help guide the evaluation, triage, and treatment of patients with headache in UC settings.

  View details for DOI 10.1186/s12913-021-07457-2

  View details for PubMedID 35135555

• Can an Artificial Intelligence Online Engine Diagnose Migraine as well as a Headache Specialist using a Semi-Structured Interview? A Multi-Center, Cross-Sectional Study Cowan, R., Rapoport, A., Blythe, J., Rothrick, J., Knievel, K., Peretz, A., Ekpo, E., Sanjanwala, B., Woldeamanuel, Y. BMC. 2021

  View details for Web of Science ID 000720429500111

• Can an Artificial Intelligence Online Engine Diagnose Migraine as well as a Headache Specialist using a Semi-Structured Interview? A Multi-Center, Cross-Sectional Study Cowan, R., Rapoport, A., Blythe, J., Rothrick, J., Knievel, K., Peretz, A., Ekpo, E., Sanjanwala, B., Woldeamanuel, Y. SAGE PUBLICATIONS LTD. 2021: 280

  View details for Web of Science ID 000725745300112

• What role do urgent care centers play in headache management? A quality improvement study of select urgent care facilities Minen, M. T., Khanns, D., Guiracocha, J. S., Ehrlich, A., Khan, F. A., Ali, A., Birlea, M., Singh, N., Peretz, A., Charleston, L. WILEY. 2021: 79-81

  View details for Web of Science ID 000657457500121

• What Role do Urgent Care Centers Play in Headache Management? A Quality Improvement Study of Select Urgent Care Facilities Ehrlich, A., Khanns, D., Guiracocha, J., Khan, F., Ali, A., Peretz, A., Charleston, L., Birlea, M., Singh, N., Minen, M. LIPPINCOTT WILLIAMS & WILKINS. 2021

  View details for Web of Science ID 000729283601237

• Horner's Syndrome and Thunderclap Headache. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques Chan, T. L., Kim, D. D., Lanzman, B. n., Peretz, A. n. 2020: 1–3

  View details for DOI 10.1017/cjn.2020.147

  View details for PubMedID 32660665

• Exploring Natural Clusters of Chronic Migraine Phenotypes: A Cross-Sectional Clinical Study. Scientific reports Woldeamanuel, Y. W., Sanjanwala, B. M., Peretz, A. M., Cowan, R. P. 2020; 10 (1): 2804

  Abstract

  Heterogeneity in chronic migraine (CM) presents significant challenge for diagnosis, management, and clinical trials. To explore naturally occurring clusters of CM, we utilized data reduction methods on migraine-related clinical dataset. Hierarchical agglomerative clustering and principal component analyses (PCA) were conducted to identify natural clusters in 100 CM patients using 14 migraine-related clinical variables. Three major clusters were identified. Cluster I (29 patients) - the severely impacted patient featured highest levels of depression and migraine-related disability. Cluster II (28 patients) - the minimally impacted patient exhibited highest levels of self-efficacy and exercise. Cluster III (43 patients) - the moderately impacted patient showed features ranging between Cluster I and II. The first 5 principal components (PC) of the PCA explained 65% of variability. The first PC (eigenvalue 4.2) showed one major pattern of clinical features positively loaded by migraine-related disability, depression, poor sleep quality, somatic symptoms, post-traumatic stress disorder, being overweight and negatively loaded by pain self-efficacy and exercise levels. CM patients can be classified into three naturally-occurring clusters. Patients with high self-efficacy and exercise levels had lower migraine-related disability, depression, sleep quality, and somatic symptoms. These results may ultimately inform different management strategies.

  View details for DOI 10.1038/s41598-020-59738-1

  View details for PubMedID 32071349

• ACEP Guidelines on Acute Nontraumatic Headache Diagnosis and Management in the Emergency Department, Commentary on Behalf of the Refractory, Inpatient, Emergency Care Section of the American Headache Society. Headache Peretz, A. n., Dujari, S. n., Cowan, R. n., Minen, M. n. 2020

  Abstract

  The American College of Emergency Physicians (ACEP) published guidelines in July 2019 on the diagnosis and management of acute nontraumatic headaches in the emergency department, focusing predominantly on the diagnosis of subarachnoid hemorrhage and the role of imaging and lumbar puncture in diagnosis. The ACEP Clinical Policies document is intended to aide Emergency Physicians in their approach to patients presenting with acute headache and to improve the accuracy of diagnosis, while promoting safe patient care practices. The Clinical Policies document also highlights the need for future research into best practices to distinguish primary from secondary headaches and the efficacy and safety of current treatment options for acute headaches. The following commentary on these guidelines is intended to support and expand on these guidelines from the Headache specialists' perspective, written on behalf of the Refractory, Inpatient, Emergency Care section of the American Headache Society (AHS). The commentary have been reviewed and approved by Board of Directors of the AHS.

  View details for DOI 10.1111/head.13744

  View details for PubMedID 31944291

• Exploring Natural Cohorts of Chronic Migraine Phenotype Woldeamanuel, Y., Sanjanwala, B., Peretz, A., Cowan, R. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965903299

• Altered structural brain network topology in chronic migraine. Brain structure & function DeSouza, D. D., Woldeamanuel, Y. W., Sanjanwala, B. M., Bissell, D. A., Bishop, J. H., Peretz, A. n., Cowan, R. P. 2019

  Abstract

  Despite its prevalence and high disease burden, the pathophysiological mechanisms underlying chronic migraine (CM) are not well understood. As CM is a complex disorder associated with a range of sensory, cognitive, and affective comorbidities, examining structural network disruption may provide additional insights into CM symptomology beyond studies of focal brain regions. Here, we compared structural interconnections in patients with CM (n = 52) and healthy controls (HC) (n = 48) using MRI measures of cortical thickness and subcortical volume combined with graph theoretical network analyses. The analysis focused on both local (nodal) and global measures of topology to examine network integration, efficiency, centrality, and segregation. Our results indicated that patients with CM had altered global network properties that were characterized as less integrated and efficient (lower global and local efficiency) and more highly segregated (higher transitivity). Patients also demonstrated aberrant local network topology that was less integrated (higher path length), less central (lower closeness centrality), less efficient (lower local efficiency) and less segregated (lower clustering). These network differences not only were most prominent in the limbic and insular cortices but also occurred in frontal, temporal, and brainstem regions, and occurred in the absence of group differences in focal brain regions. Taken together, examining structural correlations between brain areas may be a more sensitive means to detect altered brain structure and understand CM symptomology at the network level. These findings contribute to an increased understanding of structural connectivity in CM and provide a novel approach to potentially track and predict the progression of migraine disorders.This study is registered on ClinicalTrials.gov (Identifier: NCT03304886).

  View details for DOI 10.1007/s00429-019-01994-7

  View details for PubMedID 31792696

• Introducing the Migraine Action Plan HEADACHE Peretz, A. M., Minen, M. T., Cowan, R., Strauss, L. D. 2018; 58 (2): 195

  View details for PubMedID 29411373

• Migraine Action Plan (MAP). Headache Peretz, A. M., Minen, M. T., Cowan, R., Strauss, L. D. 2018; 58 (2): 355–56

  View details for PubMedID 29411363

• Interactions between affective measures and amygdala volume in chronic migraine: associations in the absence of group volumetric differences Desouza, D. D., Woldeamanuel, Y. W., Peretz, A. M., Sanjanwala, B. M., Cowan, R. P. SAGE PUBLICATIONS LTD. 2017: 47–48

  View details for Web of Science ID 000410068300064

• Validating a Screening Tool for Chronic Migraine Hindiyeh, N., Shahin, M., Zhang, N., Peretz, A., von Eyben, R., Cowan, R., Aurora, S. WILEY-BLACKWELL. 2016: 1397–98

  View details for Web of Science ID 000387856900035

• A study of adverse events attributed to Onabotulinum Toxin A for Chronic Migraine Prophylaxis Peretz, A., Zhang, N., Hindiyeh, N., Aurora, S. WILEY-BLACKWELL. 2016: 25–26

  View details for Web of Science ID 000379157200047

• Utah Aura Project, Investigating the Association between Migraine Aura and Altitude Ahmed, Z. A., Digre, K., Brennan, K., Aurora, S., Peretz, A., Baggaley, S. WILEY-BLACKWELL. 2016: 43–44

  View details for Web of Science ID 000379157200079

• Spontaneous extracranial hemorrhagic phenomena in primary headache disorders: a 120-year systematic review and pooled analysis of published case studies International Headache Congress of the International-Headache-Society Peretz, A., Woldemanuel, Y., Cowan, R. SAGE PUBLICATIONS LTD. 2015: 213–213

  View details for Web of Science ID 000354559400428

• Sudden Onset of Slurring of Speech Case-Based Neurology Peretz, A., Singh, A. Demos Medical. 2011; 1
• Subclinical Hypothyroidism: To Screen or Not to Screen? Peretz, A. NYU Langone Online Journal of Medicine. 2011 ; Clinical Correlations
• Headache and Loss of Consciousness Case-Based Neurology Kurzweil, A., Peretz, A., Singh, A. Demos Medical. 2011; 1